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Abacus Insights

Cloud-based payer data integration platform

Payer Analytics Consultant

Full-TimeUpdated
No salary listed
Senior, Expert
Bachelor's, Master's, MBA
United States
In PersonWork from anywhere; estimated travel to client sites around 25%.
Data & AnalyticsData Analysis, Business Intelligence

About the job

Requirements
  • A consulting background at a top-tier global firm or a leading healthcare-focused advisory or analytics firm; typically 3+ years of consulting experience, including client-facing analytics delivery within a healthcare payer practice.
  • 7–10+ years of total hands-on experience in healthcare data analytics, gained at a payer, third-party administrator, health plan vendor, or consulting firm serving them.
  • Demonstrated consulting craft, including hypothesis-driven analysis, structured problem solving, and executive-ready storytelling, with the ability to turn ambiguous business questions into structured data models and clear analyses.
  • Deep proficiency in SQL and Power BI and/or Tableau, with a track record of building production-grade dashboards and reporting tools.
  • Experience analyzing medical or pharmacy claims, provider performance, or payment integrity data.
  • Strong client-facing communication and presentation skills, including presenting analysis directly to client stakeholders, fielding questions in real time, and supporting consultants behind the scenes.
  • Comfort using AI-powered tools, such as Copilot-style assistants, generative AI for code or query generation, and AI-enabled business intelligence features, to work faster and surface insights more efficiently.
  • Willingness and ability to travel onsite to client locations as part of a consulting engagement team.
  • Working familiarity with payer domain concepts, including claims processing, utilization management, quality measures such as HEDIS or STAR, payment integrity, or provider contracting.
  • A bachelor's degree is required.
Responsibilities
  • Own the analytics workstream on client engagements, from scoping and hypothesis development through data modeling, analysis, and delivery of findings.
  • Partner with Payment Integrity and Payer Business Domain consultants, translating client questions into data models, reports, and analyses that support their recommendations.
  • Travel onsite to client locations with the consulting team to gather requirements, support live engagements, and build direct relationships with client stakeholders.
  • Present data findings, dashboards, and analyses directly to client stakeholders, including steering committee updates and working sessions, translating technical analysis into clear, actionable takeaways in real time.
  • Design and manage queries and data pipelines within each client’s Snowflake or Databricks environment, drawing from client claims, pharmacy, and provider performance systems to support active consulting engagements.
  • Perform deep-dive analyses of utilization trends, cost drivers, quality metrics, and provider performance, and package findings into presentation-ready outputs for consultants and clients.
  • Use AI and automation, including AI-assisted query generation and generative-AI-powered insight summarization, to accelerate analysis, reduce manual reporting, and surface findings faster.
  • Ensure data accuracy, consistency, and technical rigor across client-facing analytics deliverables.
  • Partner with Product, Engineering, and Data teams to scale, automate, and productize the analytics workflows and tools used by the consulting team.
  • Contribute reusable analytics frameworks, templates, and accelerators to the consulting methodologies as the practice scales.
  • Maintain working knowledge of payer domain concepts, including claims, utilization management, quality measures, payment integrity, and provider contracting, to ensure analytics outputs are accurate and meaningfully interpreted.
Desired Qualifications
  • An MBA, Master of Health Administration, Master of Public Health, master's degree in a quantitative field, or comparable advanced degree from a leading institution.
  • Experience with Python or another scripting language for data manipulation and automation.
  • Exposure to payment integrity, including claims auditing and fraud, waste, and abuse detection.
  • Exposure to provider performance or network analytics.
  • Experience with cloud data warehouses such as Snowflake, Databricks, Redshift, or BigQuery.
  • Experience building reusable analytics accelerators or client-ready analytics products within a consulting practice.

About the company

Abacus Insights provides a cloud-based data transformation platform for health plans that ingests data from claims, clinical records, and member eligibility and consolidates it into a unified, usable data set. It creates a 360-degree view of the patient and serves as a data layer that decouples data from analytics tools, delivering secure, HIPAA-compliant data feeds tailored to specific business uses. The company differentiates itself with payer-specific data workflows, a focus on cleaning and unifying siloed data, and leadership with deep payer and clinical expertise, enabling health plans to use their preferred analytics tools. Its goal is to help health plans improve clinical outcomes, reduce costs, and enhance member experiences by providing high-quality, accessible data for decision making.

Company Size

201-500

Company Stage

Series D

Total Funding

$132.5M

Headquarters

Boston, Massachusetts

Founded

2017

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Simplify's Take

What believers are saying

  • August 5, 2026 Payment Integrity Suite expands Abacus into a large payer spend category.
  • Tech Mahindra's September 2025 CMS interoperability partnership opens implementation-led sales.
  • Revelio shows 495 employees and 71 openings in March 2026, signaling expansion.

What critics are saying

  • Health plans already use two-to-seven PI vendors, making Abacus a replaceable layer.
  • Its 35 customers and 65 million lives create painful concentration if one flagship payer leaves.
  • CMS-0057-F standardization commoditizes interoperability, turning Abacus into a thin middleware layer.

What makes Abacus Insights unique

  • Abacus unifies claims, clinical, and non-claims data into payer-controlled infrastructure.
  • Its 150-plus connectors and 2026 AI-ready platform reduce custom integration work.
  • Blue Cross Blue Shield of Massachusetts gets updates in 15 minutes, proving operational depth.

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Benefits

  • Flexible Work Hours

Growth & Insights and Company News

6 month growth

6%

1 year growth

6%

2 year growth

3%
Associated Press
Aug 5th, 2026
Abacus Insights launches payment integrity suite with AI-powered claims auditing for health plans

Abacus Insights has launched its Payment Integrity Suite, comprising three modular solutions designed to help health plans modernise payment integrity through unified data management. The suite addresses challenges faced by health plans, which typically use between two to seven vendors and rely on disconnected data silos across claims, member, provider, contract, and vendor information. The suite includes a Payment Integrity Data Foundation that unifies PI data across internal programmes and external vendors, the CoverSelf Platform for configurable pre-pay and post-pay claim editing, and an AI-enabled complex claim audit solution that helps reviewers identify payment errors more efficiently. "Payment integrity is about far more than recovering improper payments after they occur," said Minal Patel, founder and CEO of Abacus Insights. The platform serves 35 customers covering 65 million lives.

Business Wire
Aug 5th, 2026
Abacus Insights launches Payment Integrity Suite built on trusted data.

Abacus Insights launches Payment Integrity Suite built on trusted data. A unified data foundation helps health plans improve payment integrity and prepare for AI innovation BOSTON-(BUSINESS WIRE)-Abacus Insights today announced the launch of its Payment Integrity Suite, three modular solutions that help health plans modernize payment integrity (PI) through trusted data, payer-controlled visibility, and AI-enabled innovation. For most health plans, PI processes are complex and labor intensive. Health plans use between two to seven vendors for their PI programs and rely on disjointed data siloes across claims, member, provider, contract, and vendor data. This set up is time-consuming, labor intensive, and makes it difficult to measure performance, much less to improve payment accuracy. The Abacus Payment Integrity Suite addresses these challenges by helping plans build a unified PI data foundation. Without disrupting existing vendor relationships, this solution lets plans own, see and work with all their data. Additional solution modules include transparent claims editing and AI-powered complex claims auditing. "Payment integrity is about far more than recovering improper payments after they occur," said Minal Patel, MD/MPH, Founder and CEO of Abacus Insights. "Health plans need full visibility across the entire PI lifecycle so they can identify issues earlier, improve program performance, and confidently move forward with AI. "When it comes to AI, payers can have confidence with our data solution," added Patel. "It is governed, trustworthy, and relies on human-in-the-loop supervision, so you can believe in and verify the results." The Abacus Payment Integrity Suite includes: The Payment Integrity Data Foundation Finally, a single source of truth for PI. This data foundation helps health plans unify PI data across internal programs, external vendors, and operational workflows. As a result, PI leaders can see and measure how their programs and vendors are performing. They also gain a trusted data foundation for analytics, automation, and AI initiatives. Payment Policies and Claim Editing on the CoverSelf Platform CoverSelf is a unified payment integrity platform that brings payment policies, clinical policies, and claim edits together in one place. Any policy or edit can be configured to run pre-pay, post-pay, or both. Within the Abacus Payment Integrity Suite, the CoverSelf platform delivers self-service pre-pay and post-pay PI capabilities, built on its built-in Concept Library, one of the industry's most extensive libraries of continuously updated, clinically validated content. AI-Enabled Complex Claim Audit The complex claim audit solution combines AI-powered capabilities with trusted PI data to help reviewers identify, investigate, and resolve complex claim payment errors more efficiently. By accelerating research and surfacing supporting information, the solution makes reviewers more productive while allowing humans to make final determinations. Together, the three modular solutions help health plans improve payment accuracy, streamline operations, reduce administrative burden, and establish a scalable framework for future innovation. "Our vision is to provide plans with a PI platform that grows alongside their needs," Patel added. "Whether an organization is focused on improving program visibility, increasing payment accuracy, expanding operational control, or exploring new AI-enabled opportunities, the Payment Integrity Suite provides a foundation they can build on over time." About Abacus Insights At Abacus Insights, Business Wire, Inc. believe the right information, in the right hands, at the right time, improves health. And that for too long, health payer data has been disconnected and unusable. As data is now health plans' most strategic asset, Abacus Insights' AI data platform for payer intelligence quickly transforms their messy, disconnected data into a reliable, AI-ready infrastructure. A data infrastructure that powers business-critical analytics, agents, and real-world workflows. Building this infrastructure in-house takes long implementation cycles and highly skilled teams. Its clients skip that work, instead getting a proven platform, 150+ pre-built connectors, and deep payer expertise, backed by 35 customers and 65 million covered lives. Working with Abacus lets payers transform their business and power better health.

Abacus Insights
Mar 20th, 2026
What We Heard at HIMSS26: The Payer Perspective (3 Key Shifts)

What Abacus Insights Inc. heard at HIMSS26: the payer perspective (3 key shifts). Manage Cookie Consent To provide the best experiences, Abacus Insights Inc. use technologies like cookies to store and/or access device information. Consenting to these technologies will allow Abacus Insights Inc. to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions. Contact Us

Mahindra Group
Sep 3rd, 2025
Tech Mahindra and Abacus Insights Partner to Simplify U.S. Healthcare Data Compliance

By integrating Abacus Insights' leading platform with Tech Mahindra's delivery capabilities, we are de-risking implementations and helping customers achieve future-ready interoperability at scale.

406 Ventures
Aug 22nd, 2024
Increase Medicare Star Ratings with Insights-Ready Data(TM) from Abacus Insights' Stars Performance Data Solution

Abacus Insights, the leader in data usability for U.S. payers, is launching its breakthrough Stars Performance Data Solution to equip payers with the insights-ready data[TM] to accelerate improvement in quality outcomes and member and provider experience, which will in turn boost Medicare Star Ratings.